Efficacy of intravenous thrombolysis in acute ischemic stroke decline with increasing time to treatment initiation. Guidelines recommend door to needle time (DNT) <60 minutes. Shortening DNT for thrombolytic therapy can improve treatment efficacy by reducing onset to treatment time(OTT). This study aims to determine which factors are associated with delays in DNT in our hospital and how DNT affects outcome(achieving MRS 0-1at 3 month).This will help us to design strategies to shorten time to treatment in acute stroke.This is prospective observational study of 50 cases of acute ischemic stroke undergoing thrombolysis with alteplase within 4.5 hours of onset. Study conducted at Yashoda hospital, Secunderabad during January 2015 to September 2016. We analysed relationship between DNT and following variables:pre-notification, onset to door time(OTD), age ,sex, arrival NIHSS score, BP treatment, co-morbidities, workload of ER, staff co-ordination, working days/hours, scan type, triaging errors, decision difficulty for ER physician, TIA, financial delays, lab delays, drug delays, consent delays. Outcome of patients at the end of 3 months measured on Modified rankin scale(achiving MRS 0-1). t test, Mann Whitney test, chi-square test used and multiple logistic regression analysis done using MS Office 2013 and SPSS version 20 .P value <0.05 was considered significant.We were successful in achieving DNT <60 minutes in 68% cases and we achieved Door to imaging time < 25 min in 54% cases. 74% cases achieved MRS 0 at the end of 3 months. Median DNT was 45 minutes (35-70 IQR) and median door to imaging time was 24 min(10-32 IQR).We identified ‘imaging delay’(p 0.0090,OR 7.12) due to preoccupied scan room and ‘triaging errors’(p 0.0372, OR 5.62) by treating physician to identify minor stroke symptoms and unusual presentation of stroke as independent factors delaying DNT. There was significant effect of door to needle time (P <0.01) on patients achieving MRS 0-1 at the end of 3 months. Outcome of patients treated early was good.
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